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Shibui Y, Kohashi K, Hino Y, Tamaki A, Kinoshita I, Yamamoto H, Nakashima Y, Tajiri T, Oda Y. Expression of Forkhead Box M1 and Anticancer Effects of FOXM1 Inhibition in Epithelioid Sarcoma. J Transl Med 2024; 104:102093. [PMID: 38857782 DOI: 10.1016/j.labinv.2024.102093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
Epithelioid sarcoma (ES) is a rare aggressive sarcoma that, unlike most soft-tissue sarcomas, shows a tendency toward local recurrence and lymph node metastasis. Novel antitumor agents are needed for ES patients. Forkhead box transcription factor 1 (FOXM1) is a member of the Forkhead transcription factor family and is associated with multiple oncogenic functions; FOXM1 is known to be overexpressed and correlated with pathogenesis in various malignancies. In this study, we immunohistochemically analyzed FOXM1 expression levels and their clinical, clinicopathologic, and prognostic significance in 38 ES specimens. In addition, to investigate potential correlations between FOXM1 downregulation and oncologic characteristics, we treated ES cell lines with thiostrepton, a naturally occurring antibiotic that inhibits both small interfering RNA (siRNA) and FOXM1. In the analyses using ES samples, all 38 specimens were diagnosed as positive for FOXM1 by immunohistochemistry. We separated specimens into high (n = 19) and low (n = 19) FOXM1-protein expression groups by staining index score, and into large (n = 12), small (n = 25), and unknown (n = 1) tumor-size groups using a cutoff of 5 cm maximum diameter. Although there were significantly more samples with high FOXM1 expression in the large tumor group (P = .013), there were no significant differences with respect to age (P = 1.00), gender (P = .51), primary site of origin (P = .74), histologic subtypes (P = 1.00), depth (P = .74), or survival rate (P = .288) between the high and low FOXM1-protein expression groups. In the in vitro experiments using ES cell lines, FOXM1 siRNA and thiostrepton successfully downregulated FOXM1 mRNA and protein expression. Furthermore, downregulation of FOXM1 inhibited cell proliferation, drug resistance against chemotherapeutic agents, migration, and invasion and caused cell cycle arrest in the ES cell lines. Finally, cDNA microarray analysis data showed that FOXM1 regulated cIAP2, which is one of the apoptosis inhibitors activated by the TNFα-mediated NF-κB pathway. In conclusion, the FOXM1 gene may be a promising therapeutic target for ES.
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Affiliation(s)
- Yuichi Shibui
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Pathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yuko Hino
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihiko Tamaki
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Izumi Kinoshita
- Department of Pathology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Meissner M, Napolitano A, Thway K, Huang P, Jones RL. Pharmacotherapeutic strategies for epithelioid sarcoma: are we any closer to a non-surgical cure? Expert Opin Pharmacother 2023; 24:1395-1401. [PMID: 37326105 DOI: 10.1080/14656566.2023.2224500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Epithelioid sarcoma (ES) is a rare soft tissue sarcoma subtype, predominantly occurring in children and young adults. Despite optimal management of localized disease, approximately 50% of patients develop advanced disease. The management of advanced ES remains challenging due to limited response to conventional chemotherapy and despite novel oral EZH2 inhibitors that have better tolerability but similar efficacy to chemotherapy. AREAS COVERED We performed a literature review using the PubMed (MEDLINE) and Web of Science databases. We have focused on the role of chemotherapy, targeted agents such as EZH2 inhibitors, potential new targets and immune checkpoint inhibitors and combinations of therapies currently undergoing clinical investigation. EXPERT OPINION ES is a soft tissue sarcoma with a heterogeneous pathological, clinical, and molecular presentation. In the current era of precision medicine, more trials with targeted therapies and a combination of chemotherapy or immunotherapy with targeted therapies are required to establish optimal treatment for ES.
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Affiliation(s)
- Magdalena Meissner
- Velindre Cancer Centre, Cardiff, UK
- Department of Cancer and Genetics, Cardiff University, Cardiff, UK
| | | | - Khin Thway
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Paul Huang
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
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Zhang D, Hu J, Liu Z, Wu H, Cheng H, Li C. Prognostic nomogram in patients with epithelioid sarcoma: A SEER-based study. Cancer Med 2022; 12:3079-3088. [PMID: 36073670 PMCID: PMC9939116 DOI: 10.1002/cam4.5230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/03/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The prognostic factors for patients with epithelial sarcoma remain unclear. The study aims to develop a practical clinical nomogram that predicts prognosis in patients with ES using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS We extracted clinical data from 2004 to 2015 from the SEER database about patients with ES. All patients were randomly divided into training cohort and validation cohort. Kaplan-Meier analyses were used to compare outcomes between different subgroups. In order to estimate the chance of survival for patients with ES, we developed a nomogram. Nomogram performance was evaluated by discrimination and calibration. Additionally, an analysis of decision curves was conducted to evaluate the clinical usefulness of this newly developed model. RESULTS In the primary cohort,320 met the inclusion criteria to be entered into this study. The median OS was 66.000 months (range 34.704 to 94.296 months), and the 1-, 3-, and 5-year OS rates were 70.7%, 56.1%, and 50.4%, respectively. For the validation cohort, we studied 136 consecutive patients. Age, primary site, grade, AJCC (American Joint Committee on Cancer) T, AJCC M, and surgery were included in the nomogram. The C-index values for the training set and validation set were 0.817 and 0.832, respectively. The calibration plots showed good agreement between the prediction and the observation. Based on the clinical decision curve, the model has a good clinical net benefit for ES patients. CONCLUSIONS It is the first study that developed an effective survival prediction model for patients with ES. Using this nomogram can assist in clinical decision-making as it has satisfactory accuracy. Even so, additional external validation is needed.
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Affiliation(s)
- Di Zhang
- Department of Orthopedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jintao Hu
- Department of Urology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Zhuojie Liu
- Department of Orthopedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Haoyu Wu
- Department of Orthopedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - HanWen Cheng
- Department of Orthopedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Chunhai Li
- Department of Orthopedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
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Alves A, Constantinidou A, Thway K, Fisher C, Huang P, Jones RL. The evolving management of epithelioid sarcoma. Eur J Cancer Care (Engl) 2021; 30:e13489. [PMID: 34278633 PMCID: PMC9285437 DOI: 10.1111/ecc.13489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Anneke Alves
- Sarcoma Unit, Royal Marsden Hospital, London, UK
| | | | - Khin Thway
- Sarcoma Unit, Royal Marsden Hospital, London, UK.,Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Cyril Fisher
- Department of Musculoskeletal Pathology, Robert Aitken Institute for Clinical Research, Birmingham, UK
| | - Paul Huang
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden Hospital, London, UK.,Division of Clinical Studies, Institute of Cancer Research, London, UK
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Soft-tissue Sarcoma of the Hand: Patient Characteristics, Treatment, and Oncologic Outcomes. J Am Acad Orthop Surg 2021; 29:e297-e307. [PMID: 32932303 DOI: 10.5435/jaaos-d-20-00434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/28/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The aim of this study was to describe patient characteristics, treatment, and oncologic outcomes of soft-tissue sarcomas (STSs) of the hand. METHODS Sixty-nine STSs of the hand in adult patients treated at a tertiary referral center were retrospectively included. We describe patient and tumor characteristics along with oncologic outcomes. RESULTS Epithelioid sarcoma (23%) was the most common histologic subtype, followed by synovial sarcoma (15%). Of all tumors, 17 (25%) were grade I, 22 (32%) were grade II, and 30 (44%) were grade III. The 5-year disease-free survival for epithelioid sarcomas was 75% with a disease survival of 100%, along with a metastatic rate of 15%. Of the patients with a synovial sarcoma, 40% developed metastases, and the 5-year disease-free survival was 68% and the 5-year disease survival was 73%. CONCLUSION Hand STSs are aggressive tumors with a high metastatic potential. Even with adequate oncologic treatment, long-term clinical follow-up (10 years) in these tumors is advised. The treating surgical oncologist should not be deceived by their smaller size.
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Simeone N, Frezza AM, Zaffaroni N, Stacchiotti S. Tazemetostat for advanced epithelioid sarcoma: current status and future perspectives. Future Oncol 2020; 17:1253-1263. [PMID: 33289402 DOI: 10.2217/fon-2020-0781] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Epithelioid sarcoma (ES) is an aggressive ultra-rare soft-tissue sarcoma marked by SMARCB1/INI1 deficiency. SMARCB1/INI1 deficiency leads to elevated expression of EZH2, a component of polycomb repressive complex 2, which mediates gene silencing by catalyzing H3K27me3. Tazemetostat is an oral, SAM-competitive inhibitor of EZH2, whose blockade prevents the methylation of histone H3K27, thus decreasing the growth of EZH2 mutated or over-expressing cancer cells. Tazemetostat has been approved for the treatment of patients aged 16 years and older with metastatic or advanced ES not eligible for complete resection, based on the positive results of a single-arm Phase II basket study. Tazemetostat though represents a new treatment option for ES patients, although clinical/molecular predictors of response are still to be identified. The combination of tazemetostat with other drugs like doxorubicin and immunotherapeutic agents is currently under investigation in ES patients.
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Affiliation(s)
- Noemi Simeone
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, 20133, Italy
| | - Anna Maria Frezza
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, 20133, Italy
| | - Nadia Zaffaroni
- Department of Experimental Oncology & Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, 20133, Italy
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, 20133, Italy
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Gounder MM, Merriam P, Ratan R, Patel SR, Chugh R, Villalobos VM, Thornton M, Van Tine BA, Abdelhamid AH, Whalen J, Yang J, Rajarethinam A, Duh MS, Bobbili PJ, Huynh L, Totev TI, Lax AK, Agarwal S, Demetri GD. Real-world outcomes of patients with locally advanced or metastatic epithelioid sarcoma. Cancer 2020; 127:1311-1317. [PMID: 33296083 PMCID: PMC8247010 DOI: 10.1002/cncr.33365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/29/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Limited data are available on the real-world effectiveness and safety of systemic therapies for advanced (surgically unresectable and/or metastatic) epithelioid sarcoma (ES). METHODS A retrospective medical records review was conducted in patients with advanced ES who were initiating first-line or ≥2 lines of systemic therapy (2000-2017) at 5 US cancer centers. The real-world overall response rate (rwORR), the duration of response (rwDOR), the disease control rate (rwDCR) (defined as stable disease for ≥32 weeks or any duration of response), and progression-free survival (rwPFS) were assessed by radiology reports. Overall survival (OS), rwDOR, and rwPFS were estimated from the time therapy was initiated using the Kaplan-Meier method. Serious adverse events were assessed. RESULTS Of 74 patients (median age at diagnosis, 33 years; range, 10.6-76.3 years), 72% were male, and 85% had metastatic disease. The median number of lines of therapy was 2 (range, 1-7 lines of therapy), and 46 patients (62%) received ≥2 lines of systemic therapy. First-line regimens were usually anthracycline-based (54%) or gemcitabine-based (24%). For patients receiving first-line systemic therapy, the rwORR was 15%, the rwDCR was 20%, the median rwDOR was 3.3 months (95% CI, 2.1-5.2 months), the median rwPFS was 2.5 months (95% CI, 1.7, 6.9 months), and the median OS was 15.2 months (95% CI, 11.4-21.7 months). For those who received ≥2 lines of systemic therapy, the rwORR was 9%, the rwDCR was 20%, the median rwDOR was 4.5 months (95% CI, 0.7-5.6 months), and the median rwPFS was 6.0 months (95% CI, 3.2-7.4 months). Over one-half of patients (51.4%) experienced an adverse event, most frequently febrile neutropenia (14%), pain (10%), anemia, dyspnea, fever, thrombocytopenia, or transaminitis (5% each). CONCLUSIONS Systemic therapies demonstrate limited efficacy in patients with advanced ES and have associated toxicities.
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Affiliation(s)
- Mrinal M Gounder
- Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Priscilla Merriam
- Sarcoma and Bone Cancer Treatment Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Ravin Ratan
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shreyaskumar R Patel
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rashmi Chugh
- Division of Hematology/Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Victor M Villalobos
- Division of Medical Oncology, University of Colorado Cancer Center, University of Colorado, Aurora, Colorado.,Janssen Pharmaceuticals, Inc., Spring House, Pennsylvania
| | | | - Brian A Van Tine
- Division of Medical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Amr H Abdelhamid
- Sarcoma and Bone Cancer Treatment Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | | | - Jay Yang
- Epizyme, Inc, Cambridge, Massachusetts
| | | | | | | | - Lynn Huynh
- Analysis Group, Inc, Boston, Massachusetts
| | | | | | | | - George D Demetri
- Sarcoma and Bone Cancer Treatment Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,Ludwig Center at Harvard, Harvard Medical School, Boston, Massachusetts
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Tagliaferri L, Vavassori A, Lancellotta V, Sanctis VD, Vidali C, Casà C, Aristei C, Genovesi D, Jereczek-Fossa BA, Morganti AG, Kovács G, Guinot JL, Rembielak A, Greto D, Gambacorta MA, Valentini V, Donato V, Corvò R, Magrini SM, Livi L. INTERACTS (INTErventional Radiotherapy ACtive Teaching School) consensus conference on sarcoma interventional radiotherapy (brachytherapy) endorsed by AIRO (Italian Association of Radiotherapy and Clinical Oncology). J Contemp Brachytherapy 2020; 12:397-404. [PMID: 33293980 PMCID: PMC7690224 DOI: 10.5114/jcb.2020.98120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To report the results of INTERACTS (INTErventional Radiotherapy ACtive Teaching School) consensus conference on sarcoma interventional radiotherapy (brachytherapy). MATERIAL AND METHODS An international board of multidisciplinary experts was invited to a consensus conference on the state-of-the-art of sarcoma interventional oncology during the 9th Rome INTER-MEETING (INTERventional Radiotherapy Multidisciplinary Meeting), proposing 3 statements for each one speech. At the end of each lecture, the entire group of experts was invited to vote with an electronic device. The preliminary results were presented and discussed at the end of the meeting, during a dedicated session. After the meeting, a survey was distributed within the consensus conference board to share and definitively vote the statements. RESULTS All the invited authors of the consensus conference board completed the final survey. All the 38 statements received more than 70% of agreement, 31 statements (82%) obtained an agreement of level higher or equal to 90%, 6 statements (15.8%) received an agreement level between 80% and 90%, and 1 statement (2.6%) had less than 80% of agreement. CONCLUSIONS The consensus conference demonstrated that interventional radiotherapy must be considered by a multidisciplinary management of patients affected by sarcoma.
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Affiliation(s)
- Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
| | - Andrea Vavassori
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy,
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Address for correspondence: Valentina Lancellotta, MD, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, e-mail:
| | - Vitaliana De Sanctis
- Department of Radiation Oncology, Faculty of Medicina e Psicologia, Sant’Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy,
| | - Cristiana Vidali
- Former Deputy Chair of Interventional Radiotherapy AIRO working Group – IntraOperative RadioTherapy, Trieste, Italy,
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy,
| | - Domenico Genovesi
- Department of Radiation Oncology, Santissima Annunziata Hospital, Gabriele D’Annunzio University of Chieti-Pescara, Chieti, Italy,
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy,
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy,
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy,
| | | | - Jose Luis Guinot
- Foundation Instituto Valenciano de Oncologia (I.V.O.), Valencia, Spain,
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester and Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,
| | - Daniela Greto
- Radiotherapy Department, University of Florence, Florence, Italy,
| | - Maria Antonietta Gambacorta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Vittorio Donato
- Radiation Oncology Department, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy,
| | - Renzo Corvò
- Radiation Oncology, IRCCS Ospedale Policlinico San Martino and Department of Health Science, University of Genoa, Italy,
| | - Stefano Maria Magrini
- Radiation Oncology Department, Ospedali Civili Hospital and Brescia University, Brescia, Italy
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy,
| | - Consensus Conference Board
- Consensus Conference Board: Rosa Autorino (radiation oncologist, Rome), Carmelo Caldarella (nuclear medicine physician, Rome), Annamaria Cerrotta (radiation oncologist, Milan), Antonino De Paoli (radiation oncologist, Aviano), Vitaliana De Sanctis (radiation oncologist, Rome), Nicola Dinapoli (radiation oncologist, Rome), Vittorio Donato (radiation oncologist, Rome), Martina Ferioli (radiation oncologist, Bologna), Vincenzo Fusco (radiation oncologist, Rionero in Vulture), Maria Antonietta Gambacorta (radiation oncologist, Rome), Domenico Genovesi (radiation oncologist, Chieti), Daniela Greto (radiation oncologist, Florence), Jose Luis Guinot (radiation oncologist, València), Roberto Iezzi (interventional radiologist, Rome), Barbara Alicja Jereczek-Fossa (radiation oncologist, Milan), György Kovács (radiation oncologist, Rome and Lübeck), Valentina Lancellotta (radiation oncologist, Rome), Antonio Leone (radiologist, Rome), Giulio Maccauro (orthopedic surgeon, Rome), Stefano Maria Magrini (radiation oncologist, Brescia), Alessio Giuseppe Morganti (radiation oncologist, Bologna), Michela Quirino (medical oncologist, Rome), Agata Rembielak (clinical and radiation oncologist, Manchester), Umberto Ricardi (radiation oncologist, Turin), Vittoria Rufini (nuclear medicine physician, Rome), Giuseppe Sanguineti (radiation oncologist, Rome), Luca Tagliaferri (radiation oncologist, Rome), Andrea Vavassori (radiation oncologist, Milan), Cristiana Vidali (radiation oncologist, Trieste)
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Gao W, Xue J, Ma C, Hu J. Proximal-type epithelioid sarcoma in the maxillary sinus: an unusual presentation. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:2143-2152. [PMID: 32922612 PMCID: PMC7476951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
Epithelioid sarcoma (ES) is a rare histological type of soft tissue sarcoma presenting as a subcutaneous or deep dermal mass in the distal extremities of young adults. Recently, a more aggressive, so called 'proximal-type' ES has been described. The literature is limited on the clinical features and management of ES originating in the head and neck area. We here report a case of 16-year-old female who initially presented with progressive swelling and pain in the left cheek. On physical and radiographic examination, a malignant neoplasm was found in the left maxillary sinus with bony invasion. The definite diagnosis of proximal-type ES was based on the pathological and immunohistochemical characteristics. A subtotal maxillectomy with wide margins was performed on this patient. The patient survived uneventfully for three years. This is the first report of a proximal-type ES found in the maxillary sinus.
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Affiliation(s)
- Weijin Gao
- Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Jincai Xue
- Department of Head and Neck Surgery, Gansu Province Tumor HospitalLanzhou, China
| | - Chunyue Ma
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of StomatologyShanghai, China
| | - Jingzhou Hu
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of StomatologyShanghai, China
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Epithelioid Sarcoma-From Genetics to Clinical Practice. Cancers (Basel) 2020; 12:cancers12082112. [PMID: 32751241 PMCID: PMC7463637 DOI: 10.3390/cancers12082112] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/20/2022] Open
Abstract
Epithelioid sarcoma is a mesenchymal soft tissue sarcoma often arising in the extremities, usually in young adults with a pick of incidence at 35 years of age. Epithelioid sarcoma (ES) is characterized by the loss of SMARCB1/INI1 (integrase interactor 1) or other proteins of the SWI/SNF complex. Two distinct types, proximal and distal, with varying biology and treatment outcomes, are distinguished. ES is known for aggressive behavior, including a high recurrence rate and regional lymph node metastases. An optimal long-term management strategy is still to be defined. The best treatment of localized ES is wide surgical resection. Neo-adjuvant or adjuvant radiotherapy may be recommended, as it reduces the local recurrence rate. Sentinel lymph node biopsy should be considered in ES patients. Patients with metastatic ES have a poor prognosis with an expected median overall survival of about a year. Doxorubicin-based regimens are recommended for advanced ES. Tazemetostat, an EZH2 methyltransferase, has shown promising results in ES patients. Novel therapies, including immunotherapy, are still needed.
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11
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Regalbuto A, Tudosie A, Klenotic E. A metastatic distal-type epithelioid sarcoma: Case report and review. Int J Surg Case Rep 2020; 71:144-146. [PMID: 32450373 PMCID: PMC7256202 DOI: 10.1016/j.ijscr.2020.04.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/04/2020] [Accepted: 04/28/2020] [Indexed: 11/25/2022] Open
Abstract
Epithelioid Sarcoma is a rare soft tissue tumor with an aggressive nature. Certain biomarker positivity or negativity can help distinguish from other tumors. SMARCB1 loss is predominant in most Epithelioid Sarcomas. Wide surgical excision is main treatment, but biomarker-targeted therapy is growing.
Introduction Epithelioid sarcoma is known as one of the rarest types of sarcomas and was identified as its own diagnosis by Dr. Franz Enzinger in 1970 after his realization of its massive overlap with many other diseases. This tumor has an aggressive clinical course with high recurrence and metastasis rates. Presentation of case This report will detail the case of a 39-year-old male who was diagnosed with Epithelioid Sarcoma and later succumbed to this disease. Discussion This report will emphasize epithelioid sarcoma morphology and immunohistochemistry with discussions on predisposition, prognostic factors, and current options for treatment modalities. Conclusion Future studies are needed to determine clear predisposition and screening practices; however modern pharmaceuticals have shown hopes of optimizing the course of this cancer.
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Affiliation(s)
- Avalon Regalbuto
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, 4180 Warrensville Center Road, Warrensville Heights, OH 44122, United States.
| | - Andrew Tudosie
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, 4180 Warrensville Center Road, Warrensville Heights, OH 44122, United States
| | - Eveline Klenotic
- Lake Health West Medical Center, 36000 Euclid Ave, Willoughby, OH 44094, United States
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Primary rhabdoid epithelioid sarcoma of the left thigh mimicking epithelioid rhabdomyosarcoma: A diagnostic pitfall. Int J Surg Case Rep 2020; 70:188-192. [PMID: 32417737 PMCID: PMC7229403 DOI: 10.1016/j.ijscr.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/31/2020] [Accepted: 04/16/2020] [Indexed: 11/05/2022] Open
Abstract
The diagnosis of epithelioid sarcoma based on only the clinical manifestation has proven to be difficult. Thus, the histopathology examination followed by immunohistochemistry is considered as the main modality for the diagnosis. Better understanding of clinical properties of epithelioid sarcoma will aid in deciding the best treatment for the patient.
Introduction Epithelioid sarcoma (ES) is a rare mesenchymal tumor, accounting for less than 1% of all adult soft-tissue sarcomas. The diagnosis of such malignancy is challenging. We reported a 31-year-old male diagnosed with rhabdoid ES that histologically mimicked epithelioid rhabdomyosarcoma in a 31-year-old male. Case presentation A 39-year-old male presented with pain in the left thigh. He had planned for open reduction internal fixation due to left femur fracture. During the surgery, the surgeon found abnormal appearance of the bone and the surrounding tissue. The histopathology examination showed spindle-to-polygonal epithelioid cells arranged in nodular pattern with necrotic areas. Immunohistochemistry examination revealed vimentin and CK positive expression, while myogenin was negative. Further immunostaining using CD34 and HMB45 were also negative. Discussion The diagnosis of ES based on only the clinical manifestation has proven to be difficult. Thus, the histopathology examination followed by immunohistochemistry is considered as the main modality for the diagnosis. Better understanding of clinical properties of ES will aid in deciding the best treatment for the patient.
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Frezza AM, Sbaraglia M, Lo Vullo S, Baldi GG, Simeone N, Frenos F, Campanacci D, Stacchiotti S, Pasquali S, Callegaro D, Gambarotti M, Barisella M, Palomba A, Mariani L, Casali PG, Dei Tos AP, Gronchi A. The natural history of epithelioid sarcoma. A retrospective multicentre case-series within the Italian Sarcoma Group. Eur J Surg Oncol 2020; 46:1320-1326. [PMID: 32307188 DOI: 10.1016/j.ejso.2020.03.215] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This case-series is aimed to describe the natural history of epithelioid sarcoma (ES) and to provide insights into the differential clinical behaviour of its two variants ("classic-type" and "proximal-type"). The value of a subtype-adapted grading system based on pathological features is explored. METHODS Data from consecutive, primary, localised, INI1-deleted ES operated at three Italian sarcoma reference centres (1995-2015) were included. Centralised pathological review was performed. Classic-type ES was broken down into "high-grade" and "low-grade", according to number of mitoses, evidence of necrosis and nuclear atypia. Five- and 10-year overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastasis (DM) were estimated. RESULTS Fifty-two patients were included. 5- and 10-year OS estimates were 70% and 47% in the whole series, 57% and 37% in patients with proximal-type ES, 77% and 54% in patients with classic-type ES (P = 0.02). In classic-type ES, 5- and 10-year OS was higher for low-grade (95% and 72%, respectively) than high-grade tumours (P = 0.002). 5- and 10-year CCI estimates for LR were 21% and 33% in the whole series. 5- and 10-year CCI estimates for DM were 35% and 39% in the whole series, both 28% in classic-type ES, 47% and 59% in proximal-type ES (P = 0.03). CONCLUSIONS Suffering from a proximal- or a classic-type is the stronger predictor of outcome in patients with localised ES, with proximal-type ES patients having lower survival due to a higher tendency toward metastatic spreading. However, the "high-grade" classic-type ES was associated with outcomes close to proximal-type ES.
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Affiliation(s)
- Anna Maria Frezza
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy.
| | - Marta Sbaraglia
- Department of Pathology, Padua University Hospital, Padua, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | | | - Noemi Simeone
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Filippo Frenos
- Department of Orthopaedic Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Domenico Campanacci
- Department of Orthopaedic Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Silvia Stacchiotti
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Sandro Pasquali
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Gambarotti
- Department of Surgical Pathology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marta Barisella
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annarita Palomba
- Department of Pathology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Paolo G Casali
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy; University of Milan, Department of Oncology and Hemato-oncology, Milan, Italy
| | | | - Alessandro Gronchi
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Abstract
Background and objectives: Epithelioid sarcoma (ES) is an aggressive malignancy scarcely reported on due to its rarity. This study is a review of its traits and features of prognosis and survival by analyzing both the literature and a national cancer database.Methods: Data were acquired from both the Survival, Epidemiology, and End Results database and literature. 1, 5, and 10-year Disease Specific Survival rates and hazard ratios (HR) were determined. Data were split into pre-2000 (<2000) and post-2000 (>2000) groups. Overall survival, recurrence, and metastasis rates were obtained.Results: Ninety hundred and ninety eight and 992 cases of ES were identified from the database and literature, respectively. Age, anatomical site, grade, TNM staging, treatment modality and year of diagnosis were demonstrated to be independent predictors of survival. Overall 5- and 10-year survival were 60.4% and 50.2%, respectively. Overall recurrence and metastasis rates were 63.4% and 40.3%. Using cases diagnosed prior to 2000 as reference, those diagnosed after 2000 had a worse prognosis (HR: 1.55).Conclusions: We report using the largest cohort of ES to date. Despite ES's often dismal prognosis, there are factors associated with better outcomes. A worsening survival over the years warrants further investigation into this sarcoma.
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Affiliation(s)
- Samer T. Elsamna
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kamil Amer
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Omar Elkattawy
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kathleen S. Beebe
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Romolo H, Andinata B, Aisiyah D, Budiluhur A. Sternal reconstruction for primary sternal tumor in a post-coronary artery bypass grafting surgery patient. SAGE Open Med Case Rep 2019; 7:2050313X19847801. [PMID: 31105953 PMCID: PMC6503599 DOI: 10.1177/2050313x19847801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/10/2019] [Indexed: 11/23/2022] Open
Abstract
Epithelioid sarcoma is a very rare tumor, comprising less than 1% of all soft
tissue sarcoma. Due to its rarity and benign presentation, it is often
misdiagnosed. We present a case of epithelioid sarcoma mimicking coronary artery
bypass grafting post-operative keloid. Current literature suggests the
management for epithelioid sarcoma to include surgery and adjuvant radiation. In
this patient, chest wall reconstruction was done using titanium mesh and muscle
flaps. Post-operative radiation was given and computerized tomography scan was
evaluated 3 months after reconstruction.
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Affiliation(s)
- Harvey Romolo
- Department of Cardiac, Vascular and Thoracic Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
| | - Bob Andinata
- Department of Oncologic Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
| | - Dewi Aisiyah
- Department of Plastic and Reconstruction Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
| | - Ati Budiluhur
- Department of Cardiac, Vascular and Thoracic Surgery, Dharmais National Cancer Center, DKI Jakarta, Indonesia
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Primary Epithelioid Sarcoma of Orbit: A Case Report and Review of the Literature. Case Rep Oncol Med 2018; 2018:3989716. [PMID: 30652038 PMCID: PMC6311860 DOI: 10.1155/2018/3989716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022] Open
Abstract
Epithelioid sarcoma is a rare high-grade malignancy identified by Enzinger in 1970. It accounts for 1% of all reported soft tissue sarcomas and presents most commonly in distal upper extremities in young adults with a male predominance. At this time, there are only 5 previously reported cases of primary epithelioid sarcoma of the orbit. We present a primary orbital epithelioid sarcoma case of a patient who underwent orbital exenteration followed by external beam radiation treatment. Because the literature is limited, this is to our knowledge the largest descriptive analysis of cases of orbital epithelioid sarcoma. We also provide a detailed review of all the previously reported primary orbital epithelioid sarcoma cases, as well as a discussion on the use of postoperative radiation therapy for patients with epithelioid sarcoma. Surgical resection followed by adjuvant radiation therapy appears to be a safe option for local treatment of this rare malignancy, but further future studies are needed of this rare clinical situation in order to better understand and optimize treatment for patients with orbital epithelioid sarcoma.
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Zhang X, Jiang B, Shi X, Fan C. Long period of relative quiescence in distal-type epithelioid sarcoma of the forearm with recurrence after surgery: A case report. Medicine (Baltimore) 2018; 97:e12276. [PMID: 30200169 PMCID: PMC6133439 DOI: 10.1097/md.0000000000012276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Epithelioid sarcoma (ES) is a rare malignant mesenchymal tumor that only accounts for 0.6% to 1.0% of all cases of sarcomas. ES with a relative quiescent state of more than 10 years is extremely rare.Here, we present a rare case of ES in the forearm of a 17-year-old girl. The patient had a congenital mass in her forearm that measured approximately 1cm; it grew rapidly starting 5 years ago. The mass was not treated until last year when she underwent the first surgery. The mass was located in the middle and lower part of the left forearm and involved the dorsal muscle group, intermuscular space, and subcutaneous tissues without clear boundaries.The patient underwent surgery, and the tumor recurred twice within 1 year postoperatively. METHODS The tumor samples were examined via hematoxylin-eosin (HE) and immunohistochemistry staining. RESULTS Histopathologically, the tumor comprised large polygonal epithelioid cells with abundant eosinophilic cytoplasm arranged in cell nests. Central necrosis and focal myxoid change could be seen in the tumor tissues. Immunostaining showed that the tumor cells were positive for CD34, CK, EMA, and vimentin but negative for CD31, S-100, and INI-1. CONCLUSION Based on these findings, the tumor was diagnosed as ES of distal form. Distal-type ES could have a long period of relative quiescence, after which it could grow rapidly and relapse multiple times over a short duration.
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Sambri A, Bianchi G, Cevolani L, Donati D, Abudu A. Can radical margins improve prognosis in primary and localized epithelioid sarcoma of the extremities? J Surg Oncol 2018; 117:1204-1210. [PMID: 29266231 DOI: 10.1002/jso.24955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Epithelioid sarcoma (ES) has a tendency to locally recur, spread proximally, and metastasize, in particular to lymphnodes and lungs. The aim of this report is to study the role of surgery and the extent of margins required for optimal management of patients with localized epithelioid sarcoma of the extremities. MATERIAL AND METHODS We retrospectively evaluated 77 patients affected by ES of the extremities treated at two different Institutions. RESULTS Twenty-two patients had metastasis at diagnosis. Estimated survival was 65.5% at 5 years and 50.9% at 10 years, with a better prognosis in patients with localized disease at diagnosis (P < 0.001). Among patients with localized disease, a significantly better survival was found in patients with primary tumors in which radical surgical margins were achieved (P = 0.043). Among 47 patients presenting with primary tumors, local recurrence-free rate was 72.9% at 5 years, and 61.9% at 10 years, with a better local control achieved in patients with radical margins were achieved (P = 0.026). DISCUSSION We believe that the best approach to improve both local control and survival is to aim for radical margins in patients with primary tumors. Therefore, the best chance for cure is if the first treatment is the right treatment, which we believe to be radical margins.
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Affiliation(s)
- Andrea Sambri
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Bianchi
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Cevolani
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Donati
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
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Hoshi M, Oebisu N, Iwai T, Ieguchi M, Ban Y, Nakamura H. An unusual presentation of pneumothorax associated with cystic lung metastasis from epithelioid sarcoma: A case report and review of the literature. Oncol Lett 2018. [PMID: 29541222 DOI: 10.3892/ol.2018.7868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Circumscribed solid nodules are common in pulmonary metastases from sarcoma, but cystic pulmonary metastases from sarcomas are extremely rare. An unusual case of a 33-year-old man presenting with left spontaneous pneumothorax in association with cystic pulmonary metastases from an epithelioid sarcoma in the left forearm was discussed in the present study. The patient underwent wide resection of an epithelioid sarcoma in the left forearm 6 years prior. Periodical computed tomography revealed a gradual increase in the number and size of bilateral multiple cystic pulmonary metastases despite repeated chemotherapy treatment. At 33 years of age, the patient visited the outpatient department for sudden left chest pain and dyspnea. Plain radiography demonstrated spontaneous pneumothorax in the left lung; chest tube insertion and pleurodesis were successfully performed thereafter. At the last follow-up, 24 months after spontaneous pneumothorax, he is still alive and receiving chemotherapy treatment. Spontaneous pneumothorax is a common complication associated with cystic pulmonary metastases from epithelioid sarcoma. Orthopedic oncologists need to be aware of this unusual sarcomatous metastasis during the follow-up of advanced epithelioid sarcoma.
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Affiliation(s)
- Manabu Hoshi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno, Osaka 545-8585, Japan
| | - Naoto Oebisu
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno, Osaka 545-8585, Japan
| | - Tadashi Iwai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno, Osaka 545-8585, Japan
| | - Makoto Ieguchi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno, Osaka 545-8585, Japan
| | - Yoshitaka Ban
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno, Osaka 545-8585, Japan
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Touati N, Schöffski P, Litière S, Judson I, Sleijfer S, van der Graaf WT, Italiano A, Isambert N, Gil T, Blay JY, Stark D, Brodowicz T, Marréaud S, Gronchi A. European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Experience with Advanced/Metastatic Epithelioid Sarcoma Patients Treated in Prospective Trials: Clinical Profile and Response to Systemic Therapy. Clin Oncol (R Coll Radiol) 2018; 30:448-454. [PMID: 29550245 DOI: 10.1016/j.clon.2018.02.065] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 12/01/2022]
Abstract
AIMS Epithelioid sarcoma is a soft tissue sarcoma associated with a high rate of local recurrence after wide resection and high incidence of distant metastasis. Little is known about the clinical course and response to systemic treatments in epithelioid sarcoma patients. We carried out a retrospective analysis of clinical data from epithelioid sarcoma patients to provide a reference for the design of future epithelioid sarcoma-specific studies. PATIENTS AND METHODS Data from patients with epithelioid sarcoma entered in prospective multi-sarcoma phase II/III trials were pooled: EORTC trial 62012 (doxorubicin versus doxorubicin/ifosfamide), 62043 (pazopanib), 62072 (pazopanib versus placebo) and 62091 (doxorubicin versus trabectedin). Patients had either a local or a centrally confirmed diagnosis of epithelioid sarcoma, had inoperable/metastatic disease at study entry and were eligible for the according trial. Response was assessed according to RECIST 1.1. Progression-free survival (PFS) and overall survival were calculated from date of entry. RESULTS Among 976 patients with advanced sarcomas, 27 epithelioid sarcoma patients (2.8%) were eligible for the analysis (17 men, median age at diagnosis 50 years, range 19-72). Eighteen (66.7%) received chemotherapy as first-line treatment (five doxorubicin, eight doxorubicin/ifosfamide, two pazopanib, three trabectedin) and nine (33.3%) received pazopanib as second line or later. The primary tumour was located in the lower extremity (n = 8; 29.6%), upper extremity (n = 5; 18.5%), retro/intra-abdominal (n = 4; 14.8%) and in other locations (n = 10; 37.0%). At entry, metastases were mainly found in lung (n = 17; 63%), lymph nodes (n = 9; 33.3%), bone (n = 8; 29.6%) and soft tissue (n = 7; 25.9%). The best response for first-line patients was four partial responses (22.2%), 10 stable disease (55.6%) and four progressive disease (22.2%). In subsequent lines, pazopanib achieved one partial response (11.1%), four stable disease (44.4%) and four progressive disease (44.4%). All patients but one progressed on treatment. The median PFS and overall survival were 3.8 (95% confidence interval 2.2-4.8) and 10.8 months (95% confidence interval 8.1-21.3), respectively. Five patients were still alive at the time of the according trial analysis. CONCLUSION With all limitations of such a rare disease and small data set, objective response and survival outcomes are similar in epithelioid sarcoma to non-selected sarcoma populations. The clinical testing of novel systemic treatments for epithelioid sarcoma remains an unmet medical need and a high priority.
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Affiliation(s)
- N Touati
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Litière
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - I Judson
- Royal Marsden Hospital, London, UK
| | - S Sleijfer
- Erasmus MC - Cancer Institute, Rotterdam, the Netherlands
| | - W T van der Graaf
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - N Isambert
- Centre Georges-François Leclerc, Dijon, France
| | - T Gil
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - J Y Blay
- Centre Léon Bérard, Lyon, France
| | - D Stark
- Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - T Brodowicz
- Medical University Vienna, General Hospital, Vienna, Austria
| | - S Marréaud
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Zhang Y, Liu F, Pan Y, Liang J, Jiang Y, Jin Y. Clinicopathological analysis of myxoid proximal-type epithelioid sarcoma. J Cutan Pathol 2017; 45:151-155. [PMID: 29068073 DOI: 10.1111/cup.13069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 12/28/2022]
Abstract
Proximal-type epithelioid sarcoma (ES) with a diffuse myxoid stroma is rare. Here, we report the case of a 33-year-old man with a perineal mass. Imaging showed the presence of a poorly demarcated 6.9 × 5.3-cm mass in the subcutaneous perineal region. Macroscopic examination showed that the resected tissues were partially necrotic. Histological examination showed that the tumor comprised numerous large or pleomorphic epithelioid cells with large vesicular nuclei and prominent nucleoli. A clear background of necrosis and inflammatory exudates was also present. Immunohistochemical examination showed that the tumor cells were positive for vimentin and CD34 - both of which were expressed throughout the cytoplasm - but typically did not express nuclear INI1 (SMARCB1). Hematoxylin-eosin staining (HE staining) showed that the mucin content of the tumor was approximately 80%. The patient was diagnosed with proximal-type ES with myxoid features. The patient died due to disease progression after 2 months of follow-up and without undergoing further treatment in our department. To our knowledge, only 2 cases of proximal-type ES with diffuse myxoid stroma have been reported. Proximal-type ES is rare, and this is the first case report of proximal ES with myxoid features in the perineal area.
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Affiliation(s)
- Yanyang Zhang
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Furong Liu
- Department of General Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuhang Pan
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Liang
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ye Jiang
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Jin
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Outani H, Imura Y, Tanaka T, Takenaka S, Oshima K, Hamada K, Kakunaga S, Joyama S, Naka N, Kudawara I, Ueda T, Araki N, Yoshikawa H. Clinical outcomes of patients with epithelioid sarcomas: impact and management of nodal metastasis. Int J Clin Oncol 2017; 23:181-188. [DOI: 10.1007/s10147-017-1179-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/05/2017] [Indexed: 11/28/2022]
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Mahajan A, Sen I, Hazra D, Agarwal S. Management of Epithelioid Sarcoma of the Inguinal Region with Vascular Invasion. Indian J Surg 2016; 78:315-7. [PMID: 27574351 PMCID: PMC4987559 DOI: 10.1007/s12262-015-1401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022] Open
Abstract
Epithelioid sarcoma (ES) is a rare clinically polymorphic tumor that mimics both benign and malignant conditions. It presents with dermal or subcutaneous nodules on the extremities in young adults. We present here a case of epithelioid sarcoma of the inguinal region infiltrating the femoral vessels. Biopsy is diagnostic and good histopathological evaluation is critical in management.
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Affiliation(s)
- Amit Mahajan
- Department of Vascular Surgery, CMC, Vellore, 632004 India
| | - Indrani Sen
- Department of Vascular Surgery, CMC, Vellore, 632004 India
| | | | - Sunil Agarwal
- Department of Vascular Surgery, CMC, Vellore, 632004 India
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Abstract
Epithelioid sarcoma (ES) is a rare, aggressive soft-tissue neoplasm of uncertain differentiation, characterized by nodular aggregates of epithelioid cells, which are immunoreactive to cytokeratins (CKs) and epithelial membrane antigen, and often for CD34. It has a propensity for multifocal disease at presentation, local recurrence, and regional metastasis. These are aggressive neoplasms with particularly poor prognosis after regional or distant metastatic disease, for which surgical resection is still the mainstay of treatment, and options for patients with metastatic disease remain undefined. There are 2 distinct variants: classic ES, which typically presents as a subcutaneous or deep dermal mass in the distal extremities of young adults and comprises nodular distributions of relatively uniform epithelioid cells with central necrosis, and the proximal variant, which has a predilection for proximal limbs and limb girdles and the midline of the trunk, which is composed of sheets of larger, more atypical cells with variable rhabdoid morphology. Both classic and proximal-type ESs are associated with the loss of SMARCB1/INI1 protein expression, but appear otherwise molecularly relatively heterogeneous. We review classic and proximal-type ES, discussing morphology, immunohistochemical and genetic findings, the differential diagnosis, and the future potential for targeted therapies.
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Noujaim J, Thway K, Bajwa Z, Bajwa A, Maki RG, Jones RL, Keller C. Epithelioid Sarcoma: Opportunities for Biology-Driven Targeted Therapy. Front Oncol 2015; 5:186. [PMID: 26347853 PMCID: PMC4538302 DOI: 10.3389/fonc.2015.00186] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/03/2015] [Indexed: 12/31/2022] Open
Abstract
Epithelioid sarcoma (ES) is a soft tissue sarcoma of children and young adults for which the preferred treatment for localized disease is wide surgical resection. Medical management is to a great extent undefined, and therefore for patients with regional and distal metastases, the development of targeted therapies is greatly desired. In this review, we will summarize clinically relevant biomarkers (e.g., SMARCB1, CA125, dysadherin, and others) with respect to targeted therapeutic opportunities. We will also examine the role of EGFR, mTOR, and polykinase inhibitors (e.g., sunitinib) in the management of local and disseminated disease. Toward building a consortium of pharmaceutical, academic, and non-profit collaborators, we will discuss the state of resources for investigating ES with respect to cell line resources, tissue banks, and registries so that a roadmap can be developed toward effective biology-driven therapies.
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Affiliation(s)
| | | | - Zia Bajwa
- Children's Cancer Therapy Development Institute , Fort Collins, CO , USA
| | - Ayeza Bajwa
- Children's Cancer Therapy Development Institute , Fort Collins, CO , USA
| | - Robert G Maki
- Adult and Paediatric Sarcoma Program, Tisch Cancer Institute, Mount Sinai School of Medicine , New York, NY , USA
| | | | - Charles Keller
- Children's Cancer Therapy Development Institute , Fort Collins, CO , USA
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Asano N, Yoshida A, Ogura K, Kobayashi E, Susa M, Morioka H, Iwata S, Ishii T, Hiruma T, Chuman H, Kawai A. Prognostic Value of Relevant Clinicopathologic Variables in Epithelioid Sarcoma: A Multi-Institutional Retrospective Study of 44 Patients. Ann Surg Oncol 2015; 22:2624-32. [PMID: 25663591 PMCID: PMC4521088 DOI: 10.1245/s10434-014-4294-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Indexed: 02/05/2023]
Abstract
Background Epithelioid sarcoma (ES) is an extremely rare soft tissue sarcoma. Recently, the proximal variant has been reported to be a more aggressive subtype; however, as most reports of ES have involved small case series, the actual prognostic implications remain unclear. We investigated the clinicopathological features of patients with ES to identify the prognostic factors that influence survival. Methods We retrospectively analyzed the clinicopathological features of 44 patients with ES who had been treated at our institutions between 1991 and 2011. Among these patients, 26 were diagnosed histologically as having classic-type ES, whereas the remaining 18 had proximal-type ES. Thirty-three of the patients, all without distant metastases, underwent curative surgery, and the remaining 11 with distant metastases (M1) received palliative treatment. Results The proximal subtype was significantly correlated with a proximal tumor location, distant metastases at presentation, presence of rhabdoid cells, a higher tumor grade, and vascular invasion. The overall survival (OS) rate at 5 years for the 44 patients was 45 %. A superficial tumor location and lymph node metastases (N1) at presentation were independently predictive of local recurrence-free survival (LRFS), and N1 and M1 tumors were independently predictive of distant metastasis-free survival and OS, respectively. The proximal subtype was associated with unfavorable LRFS and OS, although not to a statistically significant degree. Conclusions Proximal-type ES has significantly more aggressive clinicopathological features than classic-type ES, and lymph node or distant metastasis has the most critical impact on prognosis.
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Affiliation(s)
- Naofumi Asano
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
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Guzzetta AA, Montgomery EA, Lyu H, Hooker CM, Meyer CF, Loeb DM, Frassica D, Weber KL, Ahuja N. Epithelioid sarcoma: one institution's experience with a rare sarcoma. J Surg Res 2012; 177:116-22. [PMID: 22575361 DOI: 10.1016/j.jss.2012.04.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 03/25/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Epithelioid sarcomas (ES) are extremely rare soft tissue sarcomas. As such, their clinical behavior and response to treatment are poorly described in the literature. METHODS We queried the centralized cancer registry and pathology archives at the Johns Hopkins Medical Institution and identified 22 patients with a diagnosis of ES. We excluded two patients because of inadequate data. A pathologist reviewed patient charts and reexamined available histological slides. This study was performed with institutional review board approval. RESULTS The median age at diagnosis was 27.8 y; most patients (75%) were male. Regional lymph node metastases were present in 10% of patients at presentation. The majority of tumors (57.9%) recurred and 35% recurred more than once, although the number of recurrences did not affect survival (P = 0.48). Patients did not experience a decrease in time to recurrence with increasing number of resections. The median time between resection and recurrence was 1.23 y and the maximum was 18.8 y. Median overall survival was 56.2 mo and 5-y survival was 92%. CONCLUSIONS Our study reveals that ES is an extremely rare tumor with a protracted and recurrent course, but overall survival may be more favorable than in the past. Patients benefit from aggressive and repeated resection. Epithelioid sarcoma is unique because it metastasizes to regional nodal basins. Extended surveillance is indicated, because recurrences can appear after decades of quiescence.
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Affiliation(s)
- Angela A Guzzetta
- Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Abstract
OBJECTIVE The purpose of this article is to describe the radiologic features of unusual tumors that occur in the perineum. CONCLUSION The perineal space is often overlooked because of the infrequency of abnormalities. Accurate image interpretation and visualization of extent of pathology is important for proper management. Trauma and infectious diseases occur in the acute setting, whereas tumors are common in the chronic setting. Cross-sectional imaging plays a crucial role in depicting perineal anatomy and evaluating the extent of disease.
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Jawad MU, Extein J, Min ES, Scully SP. Prognostic factors for survival in patients with epithelioid sarcoma: 441 cases from the SEER database. Clin Orthop Relat Res 2009; 467:2939-48. [PMID: 19224301 PMCID: PMC2758965 DOI: 10.1007/s11999-009-0749-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Accepted: 01/26/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Current stratification of prognosis in patients with epithelioid sarcoma (ES) is based largely on data reported by individual centers with a limited number of patients. We sought to identify the important prognostic parameters using the Surveillance, Epidemiology, and End Results (SEER) database. We identified 441 patients with ES in the database and extracted information regarding patient demographics and clinical characteristics. Kaplan-Meier, log-rank, and Cox regression were used for analysis. Disease-specific survival declined until 100 months after diagnosis after which survival was unrelated to epithelioid sarcoma. The overall incidence of ES during 2005 was 0.041 per 100,000. The reported incidence has increased since 1973, with an annual percentage change of 5.217%. On multivariate analysis, only age younger than 16 years, local stage of disease, or negative nodes and surgical resection of the tumor predicted better disease-specific survival. We observed no increase in survival by comparing decades of diagnosis since 1986. The SEER database shows only age younger than 16 years, negative nodes, or local stage of disease and operability of primary disease independently predict survival in patients with ES. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Muhammad Umar Jawad
- Department of Orthopaedics, University of Miami Miller School of Medicine, University of Miami Hospital, 4th Floor, 1400 NW, 12th Avenue, Miami, FL 33136 USA
| | - Jason Extein
- Department of Surgery, Weill Cornell Medical College, New York, NY USA
| | - Elijah S. Min
- Ross University School of Medicine, North Brunswick, NJ USA
| | - Sean P. Scully
- Department of Orthopaedics, University of Miami Miller School of Medicine, University of Miami Hospital, 4th Floor, 1400 NW, 12th Avenue, Miami, FL 33136 USA
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Proximal-Type Epithelioid Sarcoma in the Groin Presenting as a Diagnostic Dilemma. Pathol Oncol Res 2009; 16:181-8. [DOI: 10.1007/s12253-009-9203-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 08/18/2009] [Indexed: 12/28/2022]
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Henriques de Figueiredo B, Kantor G, Bui Nguyen Binh M, Duparc A, Guerder C, Stoeckle E, Coindre JM, Bui BN. [Epithelioid sarcoma: a retrospective study of conservative treatment with initial surgery and radiotherapy]. Cancer Radiother 2007; 11:227-33. [PMID: 17652004 DOI: 10.1016/j.canrad.2007.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 06/12/2007] [Accepted: 06/28/2007] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Epithelioid sarcoma is a rare type of soft tissue sarcomas with a high risk of recurrence both local and distant. The place of surgical conservative treatment and the role of radiation therapy remain controversial. PATIENTS AND METHODS A serie of 9 consecutive patients treated with initial conservative surgery and postoperative radiotherapy (median dose of 52.8 Gy) from 1987 to 2006 in the same institution was analyzed. RESULTS With a median follow-up of 40 months (range 15-153 months), the rate of local, nodal and distant relapse is respectively 56%, 11% and 33%. The rate of death is 44.5%. No imputation has been performed. CONCLUSION Even with a high rate of local relapse observed, a conservative treatment doesn't seem to influence badly the overall survival (55.5% alive at 40 months). Indeed the rate of distant relapse and death are comparable with those found in the literature. Moreover relapse occurred almost within the irradiated volumes. An improvement of dose could be also discussed.
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Affiliation(s)
- B Henriques de Figueiredo
- Service de radiothérapie, institut Bergonié, Centre régional de lutte contre le cancer, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
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Onol FF, Tanidir Y, Tandr Y, Kotilŏglu E, Bayramiçli M, Turhal S, Türkeri LN. Proximal type epithelioid sarcoma of the scrotum: a source of diagnostic confusion that needs immediate attention: part 2. Eur Urol 2006; 49:578-80. [PMID: 16541484 DOI: 10.1016/j.eururo.2005.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Fikret Fatih Onol
- Marmara University School of Medicine, Department of Urology, Altunizade, Istanbul, Turkey.
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de Visscher SAHJ, van Ginkel RJ, Wobbes T, Veth RPH, Ten Heuvel SE, Suurmeijer AJH, Hoekstra HJ. Epithelioid sarcoma: Still an only surgically curable disease. Cancer 2006; 107:606-12. [PMID: 16804932 DOI: 10.1002/cncr.22037] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Epithelioid sarcoma is a rare soft tissue sarcoma with a known high propensity for locoregional recurrence and distant metastases. The clinical behavior and prognostic factors that influence the survival of patients with epithelioid sarcoma were studied. METHODS Twenty-three patients, including 16 men (70%) and 7 women (30%), who were treated for epithelioid sarcoma between 1979-2003 at the University Medical Center Groningen and Radboud University Nijmegen Medical Center, were reviewed retrospectively. The median age at diagnosis was 22 years (range, 1-54 years). At the time of diagnosis, 11 patients (48%) had metastases. Six patients with distant metastasis and 1 patient with an unresectable tumor received palliative treatment (30%). The remaining 16 patients underwent surgical treatment of local disease (11 patients) or locoregional disease (5 patients). Five patients in that group received isolated limb perfusion with tumor necrosis factor and melphalan. RESULTS The 5-year and 10-year disease-free survival rates for all patients were 34% and 17%, respectively; for the 16 patients who received curative treatment, both rates were 56%. In the latter group, 8 patients developed local recurrence (50%) after a median follow-up of 4 months (range, 1-14 months). Nine patients were disease free after a median follow-up of 50 months (range, 6-290 months). Tumor size >5 cm (P < .0026) at diagnosis and local recurrence (P < .0008) were significant predictors of survival. CONCLUSIONS The prognosis for patients with epithelioid sarcoma is poor, because a substantial number of patients present with extensive disease, lymph node metastases, and/or distant metastases. Treatment consists of radical surgical excision of the tumor and, if indicated, therapeutic lymph node dissection. In patients who have large tumors, isolated limb perfusion may be useful.
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Affiliation(s)
- Sebastiaan A H J de Visscher
- Department of Surgical Oncology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
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